HomeMy WebLinkAboutCC 4 CLAIM #89-52 06-18-90CONSENT CALENDAR NO. 4
6/18/90
Inter - Com
DATE: JUNE 61 1990
• 4s- Jl_ r s E_.
l
TO: HONORABLE MAYOR AND CITY COUNCIL JUN 8 1990
FROM: CITY ATTORNEY
SUBJECT: CLAIMANT: NICK DRAGONOV; D/L: 12/15/89; DATE FILED
W/CITY: 12/27/89; CLAIM NO: 89-52; CARL WARREN FILE NO:
S 6011 PRL
After investigation and review it is recommended that the
above -referenced claim be rejected and the City Clerk directed to
give proper notice of the rejection to the claimant and to the
claimant's attorney.
J0FT,. 'wROTJRKE
City Attorney
JGR:kbg(claim.frm)
Enclosure: Copy of Claim
;;LA1M AGAlN61: Th t; k-ITY ur 1.u0l1114
, l•Fo'r' Damages to Person -')or Personal Property)
Received by � L� via
IT_S . Mail
ter -office Maid
u,er the Counter
The law provides generally that a claim must be filed with the City Clerk of
the City of Tustin within 100 days after -which the incident or event occurred
Be sure your claim is against the City of Tustin, not another public entity.
Where space is insufficient, please use additional paper and identify informa•
tion'by paragraph number. Completed claims must be mailed or delivered to th(
City Clerk, The City of Tustin, 300 Centennial Way, Tustin, California 92680
TO -THE HONORABLE MAYOR AND CITY COUNCIL, City of Tustin, California:
The undersigned respectfully submits the following claim and information.rela-
tive to damage to persons .and/or personal property:
1. NAP -4E OF CLAIMANT: lJ� v �
a. ADDRESS OF CLAIMANT:
b. PHONE NO: ( / C. DATE OF BIRTH: �
SOCIAL DRIVERS
d. SECURITY NO: e. LICENSE NO:
2. Name, telephone and post office address to which claimant desires notices
to be sent, if"other than above:
This claim is submitted against:
a. The City of Tustin only.
b. The following employee(s) of the City of Tustin only:
C. The City of Tustin and the following employee(s) of the
City of Tustin only:
4. Occurrence or -event from which the claim arises:
a. DATE: ���` 9�j b. •TIME: 2('*.h• c. PLACE (Exact
and specific location): (/U2-
d. flow and under what circumstances did damage or injury occur? Specify
the particular occurrence, event, act or omission you claim caused
the injury or damage (Use additional paper if necessary). ,
r10n n) C J :-r' FAN.. <E+,�nc� , w.i r r_/V'TY/__ /00T_ (>4•"' 4�A-l! Ni
Give a description of injury, property damag_ loss so far as is
known at the time of t. claim. If there were n n]uries, state "no
njuries". �.
Ar! iv�cam' -or D l U Z (� 1� f�� fl TWv
i r --OP % i /14 Oft 2z 6 -70 &PAlo A-91 Ivtr
0A r1or'� f'�o ,CJS TZ OF /Mf -f eT w, 77Y /}S
�. Give the name (s) of the City employee (s) causing the -damage or injury:
Name and address of any other person injured:
Name and address of the ower of any damaged property:
). Damages claimed:
a. Amount claimed as of this date: /
b. Estimated amount of future costs: PA111,A17 u►til
C . Total amount claimed : _� "S `}?OP -f ,?C -bills
d. Basis for computation of amounts claimed (include copies o all ,
invoices, estimates, etc.: I�o►�- 71 M's�z -t- -
-0. Names and addresses of all witnesses, hospitals, doctors, etc.:
a
b. -
r, _
d.
ny additional information that might be helpful in considering this claim:
ARNING : IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM ( Penal Code
Section 72; Insurance Code Section 556-0)
have read the matters and statements made in the above claim and I know the
Same to be true of my own knowledge, except_as to those matters stated to be
;_con information or belief and as to such matters I believe the same to be true..
T certify under penalty of perjury that the foregoing is TRUE AND CORRECT. _
executed this 2 7 day of �r�r��-- 19 r� at Tustin, California.
IMOT ' S SIGNATURE
-)_ fice of the City Clerk, `
_'ustin, California
1 NO: DATE FILED:
devised 8/05/81
7GR: se : R: 8/5/81 (A)
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r B. A. R. # l r
AJ -105305
Joe
LgacPHE RS ON' CAUTION: PLEASE SEE OUR SERVICE ADVISOR
REGARDING NEEDED SERVICE
TOYOTA
44 AUTO CENTER DR. 2.
TUSTIN, CA 92680 3. C�
(714) 832-3355 4.
ALL PARTS INSTALLED ARE NEW UNLESS SPECIFIED OTHER -
CUSTOMER ACKNOWLEDGES RECEIPT OF COPY HEREOF
WISE. ALL NEW REPLACEMENT PARTS AND LABOR HAVE A
LIMITED WARRANTY FOR 6 MONTHS OR 6.000 MILES. SIGNED AND
WHICHEVER COMES FIRST. RECEIPTED X
DRAGANOV, N 1 C:K'- ,. C F' i;l:l t=:i >c.�2�.�I
L I ' ;VI_: DATE LII.INE 12 /2_'� /;`.,.,
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ABOR 1= K% FCIR S'T I FF `':TEER I NI 1 SINCE H I TT I 1 -EC 1 12'2 1.0 47 . ji �
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>, N51 NG BLIMP 51 : � � a
PARTS laRDERED I I
COMPLETED- o
FART'= TOY 4512o52.80:_:0 *TUBE /A TY 1 :/., 26. 52' t..-�
TOY 452 52, 28o5(C, *TUBE, ' 'f 1 _= i � :_' , cj T
TOY 45292,28. � 1 c-� # =.EAL , MAI 1 1 6. 1.c* 1 I.. 65 .0
TOY 4 C • ✓' 10 ter' , • 1*SHAFT 1-f-
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TOY 96152c:0=:i)CI *RINCS,'STR 1 . 5 . 52: 0
TOY z'526, _-.3 :0 1 0 *R I NI , I_ I I1_ 1 1 iS5 .l 6.-1
TOY 4r i252 101B L 0 CK, u J!= -
TOY
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TOY 453 10 2, 4 1 *HOUSING
i FARTS AM'fC•:=: �. 2c:� T1�'f LINE 70/• .
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LABC)R CK FOR HORk.' HONf-":; WHEN T; fRN I N1 TEI^ 1 12 . 0 - -
,
LN512' STEER 1 NI_ WHL (HIDRr%.I LII 3C ONES :TELT) NC �
FART ORDERED
COMPLETED
TOT I- l NE . t t
------------- ----------------------------------------------------
PARTS
—-------•-------_----------------•------•-------- —
F'AR I"S 6c._:9. 20
9
LABOR—MECHANICAL 47. i C)
TAX .4 6
TOTAL CHARCIES 779 , 26 -
MEI_H LAP -OR 12.� 47. c:lc TO 1' 47. 0C
PAGE 1 CiF
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CUSTOMER COPY
ON LINE SERVICE INVO!CING BY
UNIVERSAL COMPUTER SYSTEMS, INC
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